Questions & Answers | pickyeating.com.sg

Questions & Answers

 

I have a son of 11 of age. He is very fussy on food. Besides chicken/pork/duck & a little beef, he practically do not want to try other food like fish (including fish ball) & vegetables & egg which gets me worried. He's seeing a pediatrician, however the only advice I get is to try to get him eat & suggested adding Calorie into his milk (PediaSure/Ensure range)in order he could have more energy.

Currently he's on 2 teaspoon of Seven Seas Cod Liver Multivitamin syrup to boost his immunity system.

His height is 122cm & weights 22kg which is underweight.

Appreciate your advice.

Thank you

Regards
Amanda Chua

Posted on: Feb 11, 2014 | 1:45 AM

 

Dear Amanda,

Thank you for reaching out to our website for further information. We do understand your concern regarding your son’s food intake. He seems to be a highly selective eater with strong food preferences. We know it takes time, lot of patience and love to teach your child healthy eating habits. At 11, you son should be eating a healthy and well balanced diet made up of a variety of foods as it will provide all the nutrients he needs for physical and mental development.
As your child is now underweight, he needs to eat a little more that he usually does to gain weight and continue to grow well. This is also important to prepare him for the adolescent growth spurt that will occur in a few years. Vitamins and minerals alone cannot provide the energy and the macronutrients needed to support his growth.

Some tips that you can consider are:

  1. Introduction of new food – Expose him to one new food at a time. Try the new food up to 15 times before assuming it will not be taken.
  2. Create a family table for meal times and eat all meals together. Eating together is important as children often model after parents eating habits.
  3. Avoid distractions while eating (e.g. TV dinners, toys on dining table).
  4. Set an appropriate duration for meal times (20-30 minutes) for him to finish his food.
  5. Adopt a neutral attitude – avoid excessive praise, criticism, stimulation and coercion.

If your son is still refusing to increase his repertoire of food choices and eat a little more in terms of quantity, despite your best efforts, it would be important to discuss this in depth with a pediatrician who specializes in treating feeding difficulties.
In Singapore, there are three multi-disciplinary feeding clinics that will be able to diagnose the problem and provide appropriate advice and follow up. These are:

  • National University Hospital
  • KK Women’s and Children’s Hospital
  • Raffles Hospital

We hope that this information is useful for you and, that your son will soon overcome this challenge and be able to enjoy food and eating.
As learning new eating skills may take some time, you may find that PediaSure will provide nutritional support to his diet.

Ms. Anna

 

My 4-year old boy likes to drink PediaSure Chocolate milk like half an hour before he goes to sleep. In the morning, when he looks at food for breakfast, he always appears to want to throw out. My father-in-law keeps saying that it is the problem with PediaSure milk, which I now hope to check with your experts whether it is safe for children to drink PediaSure Chocolate milk like half an hour before they head to bed. Thank you.

Regards,
Loh Poh Chiang Andrew

Posted on: Feb 11, 2014 | 1:45 AM

 

Dear Sir,
Thank you for your question that we received via our website. Definitely, PediaSure Chocolate is safe for children to drink, even at bedtime.

We can understand how anxious you may be when your child refuses to eat breakfast.
To resolve this issue, it may be helpful is to understand why your child does not enjoy breakfast.

Here are some tips:

  1. Please record what your child eats throughout the day, both the type and amount of food eaten. Review the food diary with your son’s pediatrician and / or dietitian. If he is eating and drinking enough through the day, you may not need to worry about a particular meal.
  2. At the same time, you may want to study what else is happening to your child at breakfast time.  His refusal to eat at breakfast may be because he has to rush to school or he is concerned that family members are rushing to work.
  3. Take time to prepare interesting food items for breakfast; involve your son in the selection of the menu as well as the preparation of breakfast.
  4. Sit down with him at breakfast as a family and eat together.

All this may take extra time and a little planning and preparation may help. Over time, your child will learn to eat some nourishing food items or drink a nutritious drink at breakfast time.

If you need further help, you can speak with our Nutrition Advisors or visit the following website (picky eating website).

We do hope that your son will overcome this problem soon and grow up well, enjoying a variety of food items.

Ms. Anna

 

Our son Sebastien is 3 1/2 years old and is only eating porridge (several flavors), white rice, french fries, some specific biscuits and milk.

He would refuse to taste any other food we offer casually to him and totally refused to eat when we offered him rice and dishes instead of porridge when he was about 2 years old. He then got extremely upset, crying, fighting to leave his high chair and repeating "I don't want" endlessly. We gave up and have not repeated the experience since then.

He is healthy, rather tall for his age (106cm) but a bit on the light weight side (16kg).

We would appreciate your advice on the following:

- How much of a problem is this? Do we need to take strong and immediate corrective action?
- At the contrary, will it correct by itself as he grows up (in other words, there is no urgency)?
- If we take action, what are the possible strategies? Does it have to be traumatic for him?

We realize an exchange of email is not the best way to discuss this issue. We'd be more than happy to come and meet you or someone you would recommend for a consultation.

Best regards,
Marc & Serene

Posted on: Feb 11, 2014 | 1:45 AM

 

Dear Mark and Serene,

Thank you for reaching out to our website for further information. We empathize with you regarding your concerns about Sebastien’s food preferences.
He seems to be a highly selective eater with strong food preferences. We know it takes time, lot of patience and love to teach your child healthy eating habits. Nevertheless, it is important for a child’s optimal growth and development that he should eat a well-balanced diet that includes a variety of food from each food group. Persistent picky eating will compromise the nutritional quality of a child’s diet as well as his ability to eat comfortably in social situations.

Teaching Sebastien to adopt healthy eating habits does not have to be traumatic. Some tips that you can consider are:

  1. Feed at specific intervals. Allow him to be hungry before meals. This can be done by spacing meals at specific intervals (3-4 hours apart) with avoidance of snacking in between meals.
  2. Create a family table for meal times and eat all meals together to encourage him to accept new types of food as he sees you as role models.
  3. Avoid distractions while eating (eg. TV dinners, toys on dining table).
  4. Introduction of new food – Expose him to one new food at a time. Try the new food up to 15 times before assuming it will not be taken.
  5. Limit his milk intake to 500ml per day
  6. Adopt a neutral attitude – avoid excessive praise, criticism, stimulation and coercion.
  7. Since he may not be getting all the nutrients required, a complete and balanced nutrition supplement may be useful.

Picky eating behaviour can persist for many years. If Sebastien is still refusing to increase his repertoire of food choices, despite your best efforts, it would be important to discuss this in depth with a pediatrician who specializes in treating feeding difficulties.
In Singapore, there are three multi-disciplinary feeding clinics that will be able to diagnose the problem and provide appropriate advice and follow up. These are:

  • National University Hospital
  • KK Women’s and Children’s Hospital
  • Raffles Hospital

We hope that this information is useful for you and, that Sebastien will soon overcome this challenge and be able to enjoy food and eating.
As learning new eating skills may take some time, you may find that a complete and balanced nutrition supplement like PediaSure will provide nutritional support to his diet.

Ms. Anna

 

My 17-month-old daughter only weighs 8.5 kg, putting her at 3rd percentile. She has just been weaned off TBF and is now on formula milk. She drinks around 100ml to 180ml per feed at 4-hour intervals with brown rice porridge for lunch and dinner. Is there something wrong with her diet or could it be other reasons attributing to her low weight? Should I be concerned?

Jenny Goh

Posted on: February 20, 2009 | 11.43 PM

 

Dear Jenny,

You will need to bring your daughter to your paediatrician for a full assessment to ensure that she does not have failure to thrive. Before seeing him/her, there are some useful things that you might like to do. This includes plotting her growth (height and weight) from birth on the growth charts in your health booklet, as well as keeping a food diary for 1-2 weeks.

There are several factors that may suggest that her current weight may be normal. These include:

  • Not being a fussy eater with a good appetite.
  • Has no diarrhoea.
  • Has adequate weight gain (e.g.: if she has always been on the 3rd percentile for height and weight since birth).
  • If you and your husband both have a small frame.
  • It may be beneficial to see a dietician to help you design an adequate dietary programme with sufficient calories. This might include supplementing her diet with a high calorie complete and balanced formula like PediaSure.

Dr. Lim

 

 I would appreciate it if you could advise me if my 33-month-old girl, who weighs 11.2 kg, and is 91.2cm tall, is underweight? I find it a chore to feed her during mealtimes as I need about an hour to feed her half a bowl of rice. She dislikes eating fish and pork and at one time, she was diagnosed as lacking in iron due to her eating habits. She is taking 3 meals a day but in small quantities, e.g. a piece of bread for breakfast, and half a bowl of rice for both lunch and dinner. She drinks milk 3 times a day (morning, afternoon nap and just before her sleep) and usually about 140ml per bottle. She'll reject any more quantities of milk. Is she drinking below the average quantity recommended? May I know if there's any appetite booster that can enhance her appetite and encourage her to eat more? Thank you.

May Li

Posted on: May 21, 2009 | 6.43 PM

 

Dear May Li,

If you plot your daughter's height and weight on her percentile charts (available in her health booklet), her weight lies on the 25th percentile and her height is on the 50th percentile. This means that she is within the normal band for height and weight compared to her peers. However, it is also important to measure her rate of growth. This is done by plotting her previous height and weight on the same graph. If she shows adequate weight and height gain (ie. following the lines on the percentile charts), then she is growing adequately. It sounds like your daughter is a fussy eater. You might like to speak to your paediatrician and design an appropriate approach to deal with her fussy eating habits. This may include planning a proper feeding regime, offering her a variety of food and maybe using appetite stimulants which are usually a mixture of vitamins and lysine. In addition, fussy eating children who are not growing adequately may benefit from some supplementation with high calorie complete formulas. Most 3-year old children will drink milk 3 times per day.

Dr. Lim

 

My 13-months old baby girl currently weighs 9kg and height is 72cm. I have checked under the Growth assessment and she is below the 50 percentile. Can I know what it means? Is she seriously underweight? I am very worried about her daily meal intake as she does not eat as much rice as other kids. But she loves bread. Should I feed her with bread and meat instead of using rice? I do not add any flavourings such as sugar, salt and soya sauce into her food. Does that affect her intake?

Jessica Ling

Posted on: May 21, 2009 | 6.43 PM

 

Dear Jessica,

Using the percentile charts in your baby's health booklet will give you an idea where your daughter's height and weight is in reference to her peers based on age. Children vary in height and weight at every age. The 50th percentile refers to the average weight or height for each age group. The 97th percentile refers to the upper limit in each age group, and the 3rd percentile refers to the lower limit in each group.

Although your daughter is below the 50th percentile, she is above the 3rd percentile. Hence she is not underweight. As she grows older, you will be able to plot her rate of growth on these growth charts. Do not worry about her growth as long as she is growing proportionally along the percentile lines.

Rice and bread are both rich sources of carbohydrates. Thus you may use bread as a substitute for rice in her meals. Adding flavouring is not necessary. However, it is alright to add them as long as it is not in excessive amounts.

Dr. Lim

 

My son is 29 months and weighs only 10kg. His nanny informs us that he eats a lot at her house, but when he is with us on weekends, he eats only a little. He is a very active boy. We wonder if he is underweight. How can we make him eat more?

Ng Shao Jiuan

Posted on: May 21, 2009 | 6.43 PM

 

Dear Shao Jiuan,

It is important to speak to your paediatrician regarding your son's poor weight gain. Before doing so, you might like to keep a diary of his daily intake for 1 - 2 weeks. Try to work with your nanny to accurately document how much he eats as well as his eating habits and the timing of meals. You will need to rule out any other medical condition that can cause poor weight gain in a two and a half year-old boy. Your doctor may do some screening investigations which may include blood, stool and urine tests. If his weight gain is due to poor calorie intake (e.g. fussy eating, poor appetite), then supplementing with high calorie complete formula while retraining him to eat proper meals might be useful. As your child needs to learn to eat a wide variety of wholesome foods, it is important not to rely solely on the supplement as his source of nutrition.

Dr. Lim

 

My son is 3 years and 4 months old. His weight is now 14kg and height 100 cm. Compared to his friend he looks thin, he drinks milk 3 times a day, having meals 4 times a day. His meals include meat/fish with vegetable and also fruits after meal. But it seems that my son has trouble in gaining weight. Do you have any suggestions that might help? Thanks.

Tiarlin

Posted on: May 21, 2009 | 6.43 PM

 

Dear Tiarlin,

Based on an Anthropometric Study on Pre-School Children in Singapore done in Year 2000 by the National Healthcare Group Polyclinics, your son is around the 75th percentile for height and the 38th percentile for weight. That is why he seems to look thinner. This may reflect a genetic build and / or relate to his nutritional status. So, one of the things you could do is to see your son's paediatrician and discuss his growth pattern over time. Your doctor will be in the best person to advice on the next steps.

I am glad that your son eats a variety of foods at every meal. A healthy diet is a well-balanced one that includes grain foods (like rice, bread, and noodles), fruit, vegetables, meat / fish (or other protein rich foods such as eggs, tofu and nuts) as well as milk. If the doctor suggests that your son needs to gain weight you can work with a dietician to get a diet plan that indicates the portions of each food group that are suitable for his age, to achieve the rate of weight gain that the doctor would like to aim for over a specific period of time.

To help your child gain weight you may need to increase the calories in the diet. One simple way is to consume a high calorie complete and balanced formula that is designed to support the diets of children who are picky eaters or are not eating well. During the period that you would like your son to gain weight at a little faster pace, you can use 3 glasses of a complete and balanced formula instead of milk to increase the calories in the diet. It is important to follow up with your dietician and doctor to ensure that your little one gains weight appropriately.

Ms. Anna

 

My son is exactly 5 years old, and he's been underweight since three. He now weighs 15.2kg and his height is 107-108cm. He's been on a complete balanced formula since 3 too. His daily intake consists of 3 bottles of 8-9oz of this formula and 1 snack in school, lunch with porridge or noodles and dinner with rice. Is this enough? I don't know how I can help to increase his weight further. Thanks.

Yvonne

Posted on: May 21, 2009 | 6.43 PM

 

Dear Yvonne,

Every child should eat a well balanced diet made up of a variety of nutrient-dense foods. Ideally, your daughter should eat the foods and servings daily as recommended by the Health Promotion Board in their publication titled "Birth to Eighteen Years – Dietary Tips For Your Child's Well-Being". You can download a copy from their website for reference.

As your child is underweight, it is important for you to consult a paediatrician and a dietician to assess your son's growth and food intake on a regular basis. Your healthcare team will be able to provide accurate and individualized advice in face-to-face sessions.

If your child is active, at his weight and height, he needs about 1500 kcal each day to maintain weight. He may need to eat a little more than this each day, to begin to gain weight. The exact amount is best determined by the dietician.

You will now need to write down the exact portion of all that he eats at school and at home for a period of three to seven days, taking care to specify the quantity. Bring this food diary to the dietician to assess exactly how many calories he eats each day. Based on this, you will be advised how to improve his diet.

Ideally, your child should eat a variety of foods, each in the right portion, to make up a well balanced diet. The complete balanced formula your child is consuming will support his energy and nutrient needs as he achieves an age-appropriate eating pattern.

Ms. Anna

 

My daughter is a very hyperactive child and to my surprise, at a very young age (9 months), she could already walk, dance and hum to music. She could still remember an old song from a VCD that she had listened to since 3 months. My child is very alert and is also a fast-learner.

But my concern now is that my daughter is drinking less milk than usual. She only drinks 90ml since young till 9 months. After that till 14 months, she drank up to 120ml. Between 14 to 17 months, she drank up to 150ml. And recently, her milk consumption has fallen to 90 – 120ml.

Is the milk consumption nutritious enough for her age as she takes it 3-4 times? She hardly has a proper meal – only eating a very small portion of the serving (2-4 baby spoon) scoop. Each time I brought my daughter for checkup, the nurse would always say that she is underweight although she's slightly taller than average kids of her age. How do I ensure my daughter finish her meal? Perhaps you could advise me on any food preparation or even substitute food for my daughter?

Haryani

Posted on: May 21, 2009 | 6.43 PM

 

Dear Haryani,

It is wonderful to hear about the developmental milestones that your child achieved. Milk is an integral part of a child's well balanced diet. The Health Promotion Board (Singapore) (HPB) recommends the following amount of milk to be consumed each day:

For more information about a well balanced diet for your child, download the booklet, "Birth to Eighteen Years: Dietary Tips for Your Child's Wellbeing". The objective of this booklet is to provide the general public with relevant and practical information on the dietary recommendations for children and adolescents in Singapore aged between 0-18 years. This booklet is available in English, Chinese, Malay and Tamil from http://www.hpb.gov.sg/hbp/default.asp?pg_id=935 Currently, your child is not consuming enough milk as per the recommendation from HPB. If your child's diet and growth pattern is a constant worry, please discuss it with your child's paediatrician and make an appointment to see a dietician at a hospital or a polyclinic.

In the interim, as she learns to eat a little more, you may also try giving your child a higher calorie formula that is designed to provide complete and balanced nutrition for children who are picky eaters or are not eating well.

Ms. Anna

 

My 17-month-old daughter only weighs 8.5 kg, putting her at 3rd percentile. She has just been weaned off total breast-feeding and is now on formula milk. She drinks around 100ml to 180ml per feed at 4-hour intervals with brown rice porridge for lunch and dinner. Is there something wrong with her diet or could it be other reasons attributing to her low weight? Should I be concerned?

Jenny Goh

Posted on: May 21, 2009 | 6.43 PM

 

Dear Jenny,

ou will need to bring your daughter to your paediatrician for a full assessment to ensure that she does not have failure to thrive. Before seeing him/her, there are some useful things that you might like to do. This includes plotting her growth (height and weight) from birth on the growth charts in your health booklet, as well as keeping a food diary for 1-2 weeks.

There are several factors that may suggest that her current weight may be normal. These include:

  1. Not being a fussy eater with a good appetite.
  2. Has no diarrhoea.
  3. Has adequate weight gain (e.g.: if she has always been on the 3rd percentile for height and weight since birth).
  4. If you and your husband both have a small frame.

It may be beneficial to see a dietician to help you design an adequate dietary programme with sufficient calories. This might include supplementing her diet with a high calorie complete and balanced formula.

Dr. Lim

 

My 5-year old boy, Jin Rei, weighs 22kg and is a vegetarian. However, he is a picky eater and dislikes beans and vegetables. I have to hide these in his rice or mince them up to get him to eat. He loves tofu though and eats it all the time. I have also noticed that his urine gives off a very strong, sourish smell. Is there cause for concern?

Felicia Ho Siew Hui

Posted on: May 21, 2009 | 6.43 PM

 

Dear Felicia,

Like adults who are vegetarians, it is important to ensure that Jin Rei is getting a balanced diet. Unbalanced vegetarian diets sometimes lack iron, calcium, vitamin B12, protein, and zinc. Some of these are essential for Jin Rei's growth and can be supplemented by his current complete and balanced milk formula. To determine if his current growth is appropriate, plot both his height and weight on the graphs available in your health booklet. Based on the information provided, his current weight of 22kg is appropriate for his age. The main problem that you will need to address is his eating habits. As he is a fussy eater, you will need to design balanced vegetarian meals that he will like. There are books available to assist you in this and you may also want to consult a paediatric dietician.

There is an ongoing debate on whether excessive intake of tofu is harmful to a child due to the preservatives and other substances used in the manufacturing process. Generally, he should be alright if he eats tofu in moderation. Also, try using fresh tofu (e.g. from a wet market) or those which have no preservatives. As for the sourish smell of his urine, it may not be due to the tofu he is eating. If it persists after you cut down his tofu intake, then you are advised to send him for a urine test to ensure that there is nothing else wrong.

Dr. Lim

 

My baby is 13 months old. He was feeding well, eating porridge, cereals and fruits but recently, his eating habits have started to deterioriate. He is taking a long time to swallow his food, even pureed ones. Before, he could chew and swallow pieces of fruit. But now, he sometimes gags and vomits. He also doesn't eat as much. He is active and doesn't look unwell. Why is he regressing? Is he getting fussy with food or is it part of a developmental process?

Yap Yin Fong

Posted on: May 21, 2009 | 6.43 PM

 

Dear Yin Fong,

Calen's behaviour may be normal. Try varying both his food as well as its texture. Go back to the basic foods that he likes. Also try feeding him solids before letting him drink his milk. You might like to visit a dietician for some advice.

It is important to ensure that Calen's other developmental milestones are appropriate, and that he does not gag or vomit when he drinks fluids.

He will need further evaluation by your paediatrician if he has other regressive milestones.

Dr. Lim

 

My daughter is now 14 months old but refuses to drink more than 120ml per intake (no more than 500ml a day). I am worried if her milk intake is sufficient for her age. She eats about 2 bowls of porridge a day plus some fruit. Is her intake of solids affecting her appetite for milk? Thanks!

Hew Chee Chin

Posted on: May 21, 2009 | 6.43 PM

 

Dear Chee Chin,

Your daughter is 14 months old, as per the guidelines for a well-balanced diet in Singapore, she should be drinking 750 ml (3 cups) of milk each day as part of a diet that also includes grains, fruit, vegetables, meat or fish or beans in age-appropriate portions. If you need more information about a well-balanced diet that is suitable for your child, please download the booklet, "Birth to Eighteen Years: Dietary Tips for Your Child's Wellbeing" from the Health Promotion Board's website at: http://www.hpb.gov.sg/hpb/default.asp?pg_id=935

As children do have small tummies when compared with adults, they will eat smaller portions of food at each meal. If the bowl of porridge at lunch is too large, it may not make her hungry enough to want to drink milk in between her meals. So, it is important to give her the right portion at each meal and snack, so that she is hungry enough to include milk. You may want to speak with a dietician for more personalised recommendations on the most suitable portion for your child.

At this age you should also be encouraging your child to eat a wide variety of food. So, in addition to the occasional bowl of porridge, offer her many different kinds of foods for breakfast, lunch, dinner and snacks. All the new varieties of flavours and textures may also help get your child more interested in eating as well.

Encourage your child to be active. As your daughter runs and plays, she will also work up an appetite that will help her to also consume the appropriate amount of milk.

Ms. Anna

 

My daughter who is turning 5 has just started using a complete and balanced formula since she doesn't eat proper meals. Is this enough for her?

May Ng

Posted on: May 21, 2009 | 6.43 PM

 

Dear May,

very child should eat a well balanced diet made up of a variety of nutrient-dense foods. Ideally, your daughter should daily eat the foods and servings as recommended by the Health Promotion Board in their publication titled "Birth to Eighteen Years – Dietary Tips For Your Child's Well-Being". You can download a copy from their website for reference.

However, during childhood, some children do become fussy about food, reject certain foods, whole food groups or eat very little. This may last just a few days which is not worrisome. But, for some other children this pickiness may go on for a while, even as parents work towards helping their children eat well-balanced diets.

As children grow rapidly, lack of energy and nutrients, for extended periods of time, may compromise growth and wellness. It is important to encourage your child to eat proper meals. However, this may take some time and cause a lot of anxiety and tension at home, straining your relationship with your little one.

A 5 year old child should achieve 1850 kcal per day as per the Recommended Daily Dietary Allowances For Normal Healthy Persons in Singapore (Children) published by the Health Promotion Board. During this period, your child may not eat enough to achieve this calorie target. So, a complete and balanced formula will help to provide the rest of the calories and meet her daily need for the many important nutrients.

Ms. Anna

 

How much milk does a 2-year-old (and above) require daily?

Chong Pui Chih

Posted on: May 21, 2009 | 6.43 PM

 

Dear Pui Chih,

he Health Promotion Board recommends milk as part of a healthy and well-balanced diet. In the recent publication titled "Birth to Eighteen Years – Dietary Tips For Your Child's Well-Being", the Board recommends that children consume the following quantity of milk each day.

Milk is a great source of many beneficial nutrients, the most notable being calcium. So, encourage your child to consume the appropriate amount of milk each day.

There are many milk varieties available in the supermarket including those specially formulated with additional nutrients to add value to your growing child's diet.

Ms. Anna

 

My son is 18 months old now. I started feeding him solid food when he was 10 months old but he does not eat much and likes to keep food in his mouth for very long before he swallows. One small bowl of porridge takes him up to 2 hours to finish. In fact, he does not like to eat anything at all, except for tidbits. He weighs only 10kg now. Is it normal for children his age to behave this way? What can I do to improve the situation? Thanks.

Looi Lai Fun

Posted on: May 21, 2009 | 6.43 PM

 

Dear Lai Fun,

Klein sounds like he is a fussy eater. Basically, there are two issues that need to be addressed.

The first issue is his current feeding habits. This is a common problem faced by many parents and there are many techniques which may help. Some of these include:

  • Make meal times an enjoyable experience
  • Offer him a variety of food apart from the boring blended porridge
  • Limit feeding time to a maximum of twenty minutes
  • Avoid rescuing incomplete meals with a second feed as it tells your child that his current feeding habit is an acceptable practice
  • Space out his feeding regime so that he is truly 'hungry' before meal times
  • Keep feeding time to a standard regime
  • Allow the same caregiver to feed him initially to standardise feeding techniques
  • Consider appetite stimulants
  • Set incremental goals (e.g. from finishing half bowl to three quarter bowl) and reward him if he meets these targets
  • Praise him if he swallows his food
  • Use peer pressure (e.g. siblings or other children feeding together and finishing their food)

The second issue is his poor weight gain. Assuming his height is normal, his current weight of 10kg would put him on the 25th percentile for an 18-month-old boy (refer to the charts in your health booklet). This is still within the normal range.

Your task now is to maintain or improve his current weight and rehabilitate his feeding habits. My suggestion is to address his fussy eating habits first while monitoring his growth parameter over six months. His weight may fluctuate a little during the initial stages of his feeding rehabilitation so do not be too alarmed. If it falls significantly, you may want to change his milk to complete and balanced formulas to help maintain his weight.

If you find no improvement over six months, then you might like to enlist the help of your Paediatrician or Dietician.

Dr. Lim

 

My son has just turned 1 on Feb 25 and seems to be hungry all the time. At the moment he has milk and cereal for breakfast. An hour later he snacks on half a piece of digestive biscuit and water, naps and then wakes up for lunch (home-made porridge). Two hours later he has fruit, naps and then wakes up for the other half of the digestive biscuit and water. An hour later, it's dinner time (home-made porridge). Sometimes, he also asks for milk in between. I'm presently still nursing him in the evenings when I get back from work. His bowel movement is daily and normal. He is growing taller but thankfully not rounder. Is he eating too much? Can you suggest some healthy snacks?

Celestine Yeo

Posted on: May 21, 2009 | 6.43 PM

 

Dear Celestine,

Some children have growth spurts when they have a higher calorie requirement. This is a good concern to handle. Just ensure that he snacks on healthy food. Some suggestions are wholemeal bread or biscuits, fruits such as apple, pear, papaya, honeydew or oranges, brown rice cereals, cheese and yoghurt, barley, red or green bean soup and plenty of plain water. He should also be encouraged to exercise and be active.

Dr. Lim

 

Is there a recommended amount of milk that children should take daily? I have a 13-month-old girl and 35-month-old boy. Ever since they started taking solid food, their milk consumption has dropped to about three times a day. I am concerned with whether they are drinking enough milk to meet their recommended daily calcium intake.

Janet

Posted on: May 21, 2009 | 6.43 PM

 

Dear Janet,

A 13-month-old girl will generally take three to four milk feeds a day; a 35-month-old boy will take three milk feeds a day. However, this is only a general guideline and depends on how much milk they are taking during each feed, and on how much solids are they eating. Like adults, children require a specific amount of calories a day. Once they start taking solid food, their milk consumption naturally decreases, depending on the amount of solids they are taking. You should be monitoring their growth parameters instead of the number of milk feeds they are taking. If they are growing well, then do not be too concerned about their milk intake.

Calcium requirements in a child vary during different stages of their growth. Here is a rough guide: A toddler between the ages of one to three years needs two glasses of milk a day, if milk is his only source of calcium. A preschooler between the ages of four to eight years needs three glasses of milk a day. Aside from milk, there are many other sources of calcium such as fish, dairy products like cheese and yoghurt, and vegetables like spinach and broccoli.

Dr. Lim

 

Hi. My daughter is now 2 years old.  For the past 1 month, she totally refuses porridge & she dislikes rice no matter how we try to coax her.  She wants milk & eats bread, cake & biscuits.  It is only now that her milk intake is about 750ml which is the recommended volume of milk for a 2 year old. 1 month before, she usually took like half to three-quarter bowl of porridge each meal usually with much coaxing which at that time her milk intake is around 500-600ml per day. What should we do?  Is it ok if a child took milk & bread solely at this time? Thanks.

Ms. Chew

Posted on: May 21, 2009 | 6.43 PM

 

Dear Ms. Chew,

Like many other two-year old children, your daughter is going through a period of food selectivity. Naturally you are concerned about your child's nutritional status as food refusal has gone on for over a month. As a mother, you need to continue to continue to offer your daughter a wide variety of foods from each of the four foods groups – rice and alternatives, fruit, vegetables and meat and alternatives (which include dairy products such as milk, yogurt and cheese) – so that she can eat a well-balanced diet. This may take time but, you have to keep trying.

Just as the name rice and alternatives' suggests, it is fine to offer rice or bread or noodles or pasta as the choice from this food group as in general all these foods are good sources of carbohydrates that provide energy to support growth and activity. So, if your child does not like rice or rice porridge offer her bread, noodles, pasta or biscuits. However, try to serve healthier choices as often as possible. For example, offer items made with wholegrains and have less sugar and salt. This means offering her raisin bun or wholegrain biscuits instead of doughnuts or cakes.

In addition, remember not to use pressure to coax her to eat as recent studies have shown that it does not help a child eat more and may create negative associations with the food and strain family relationships. Try positive reinforcement and set a good example – eat with her and demonstrate how you select a variety of foods. While your daughter is learning to eat a wider variety of foods, you can use a nutrient dense complete balanced supplement to support her nutritional needs.

Ms. Anna

 

I have a delightful 4 year old girl who is extremely bubbly, happy and very, very active! She likes going for the various classes we send her to such as swimming and ballet. She also constantly spends her time playing with her cousins. I feel very blessed to have such a lovely child! However, there is one concern that I do have - my little girl is very skinny! Although she is 110cm, she only weighs 12.5kg. As she is always running around, we have difficulty getting her to sit down for long periods of time to eat a full meal (she usually only eats about two-thirds of the food we serve her). I am worried she is burning away what little food she is taking which causes her to be so skinny! Is her skinniness due to her food intake and activity level or could there be any other problems with my child? And, what can I do to encourage her to sit down and eat more?

Mary Koh

Posted on: May 21, 2009 | 6.43 PM

 

Dear Mary,

Active children are generally healthy children. It is good to note that your daughter is very active and enjoying games and classes. A child's weight and height status is affected by many factors including genetics, age, and activity level. You can track your child's growth using the health booklet. Your child tracks around the 97th percentile for height and 25th percentile for weight. That is why she looks 'very skinny'. If she is not eating well it may compromise her natural potential to grow and, also impact her ability to resist infections. If you are still concerned about her weight, please consult your child's pediatrician.

Meal times are important. Set family ground rules regarding the expected behaviour at meal times. To help your little one learn to concentrate on eating, remove distractions such as toys and television, during meal times. Also, place her food portion before her and encourage her to complete the meal. If she does not, remove the remaining portion in about 20 minutes.

If your pediatrician confirms that your child needs to catch up on weight, then, offer her small and nutritious snacks in between meals to increase caloric intake. Some children find it easier to drink than eat, and if that is the case with your daughter, offer her a higher calorie beverage that is nutrient dense and complete, to help her achieve her ideal weight for height.

Ms. Anna

 

My boy, who will turn 4 this year, started his nursery school in January this year. I noticed that he is the smallest among his classmates - he weighs 14kg and is 98cm tall. Is this normal for a boy his age? Also, what can I do to make him bigger and taller like the rest of his classmates?

Nurazizah Zain

Posted on: May 21, 2009 | 6.43 PM

 

Dear Nurazizah,

Your son is on the 25th percentile for both height and weight for age. A child's height and weight depends on many factors including genetic inheritance, age, activity level and nutrition. What is important is that your child grows steadily along his percentiles for height and weight and that he is active and stays well.

Good nutrition supports optimal growth especially when the growth spurt comes along. The best thing any mother can do is to provide him with a healthy and wholesome diet, encourage regular exercise and sufficient rest and relaxation.

Ensure that your home diet includes a variety of wholesome foods and encourage your child to eat. If you notice that he eats small amounts or avoids certain foods, you may want to provide an energy dense supplement that delivers all the known nutrients in the appropriate amounts. However, be careful not to force feed or overfeed. Force feeding does not help your child develop a healthy attitude with regard to food or eating. Overfeeding may make him gain too much weight and make him overweight for his height.

Ms. Anna